The potential of role of informatics in the future of medicine is immense. Medical leaders have voiced concern and the emerging idea of performance indicators for radiology departments will soon become the standard of practice. These indicators will serve to gauge the performance of licensed radiology departments, but they will provide no quantification of the work upstream in the medical pipeline: proper utilization of radiological imaging. Few individuals have realized this deficit in gauging radiology; thus, the research in this area has been limited.
The only factors that can be used to gauge utilization of radiology are economic and statistical. Intuitively it would seem an economic based quantification system would be more pragmatic. However, a gauge based on imaging costs and cost-effectiveness is impractical as it cannot be extrapolated across institutions readily. One whole body computed tomography (CT) examination at a particular institution may be billed as a single unit, yet the same exam may be broken into separate billing codes for chest, abdomen, and pelvis at another institution. Further, the assignment of relative value units (RVU) to individual products or services and allocation of overhead costs may vary between institutions. Thus, using an economic based quantification system to gauge radiology utilization across institutions and departments is impractical, inefficient, and inaccurate.
In contrast, gauging the utilization of radiology by a statistical quantification system lacks the negative factors found in an economic based system. Specifically, gauging the utilization of radiology by positive scan rates bypasses the differences created by variations in billing codes seen in different institutions. For example, a positive aortic dissection multi-detector CT (MDCT) in one Radiology Department would be considered a positive aortic dissection MDCT in a second Radiology Department given the proper imaging findings. Therefore, quantifying radiology utilization through imaging protocol positive scan rates is the only viable method to compare use across institutions and departments objectively. However, economic based imaging gauges can serve a role for internal or departmental analysis.
Once normalized radiology utilization gauges are created, further steps into normalizing and then comparing other downstream metrics becomes possible.